Judy Bullard, a painter who lives in Old Orchard Beach and receives Medicaid benefits, has epilepsy and says the condition prevents her from working regularly. Staff photo by Brianna Soukup

Gov. Paul LePage cheered the Trump administration Thursday after Medicaid officials opened the door for states to impose work requirements on Medicaid recipients, a policy long sought by Maine’s Republican governor.

It's unclear, under the policy change whether Judy Bullard, holding her dog, Skylar, might be required to work or volunteer to get Medicaid that helps pay to treat her epilepsy. Staff photo by Brianna Soukup

Maine had filed a request with the U.S. Centers for Medicare and Medicaid Services last spring to receive a waiver that would allow the state to set requirements for work, volunteering or other approved activities as a condition of receiving Medicaid. The proposal also would charge monthly premiums ranging from $10 to $40 – depending on income – to low-income residents. Nine other states also have filed requests for waivers.

It’s unknown when the waivers would be approved, but with the Trump administration giving its blessing, action could be soon, possibly within a matter of days for Kentucky, which filed the first application.

Currently, 64 percent of the 100,000 non-elderly, non-disabled adults who receive Medicaid in Maine are employed, according to the Kaiser Family Foundation. It’s unclear how many of the remaining able-bodied recipients would fall under the new requirements. Maine has a total of 268,000 Medicaid recipients, including children and people who are not physically able to work.

LePage released a statement praising the Trump administration for giving states the ability to add the requirements.

“Most people have something to contribute to their community through either work or volunteering, and people who can contribute should do so,” LePage said. “Although the details on Maine’s waiver request still must be worked out, this decision by CMS is a critical first step. Under our proposal, people who receive Medicaid and are able-bodied will need to work, be training for a new career, or volunteer.”

POLITICS, LAWSUIT, RED TAPE

An advocacy group in Maine vowed to fight the waiver, arguing that it’s illegal and that the current Medicaid program supports work by giving people access to health care, making them more likely to stay well enough to be employed.

Robyn Merrill, executive director of Maine Equal Justice Partners, said her group would file a lawsuit seeking to stop the waiver from taking effect as soon as one is approved in Maine. In addition to the 268,000 Mainers now on Medicaid, another 70,000 could become eligible as a result of November’s popular vote to expand the program to childless adults.

“This is a political move to take health care away from people,” Merrill said. “Federal Medicaid laws do not permit work requirements. This is illegal. The (Trump) administration doesn’t have the power to waive what isn’t in the law, unless Congress were to change the law.”

Merrill said the new requirements will create red tape and make it cumbersome to apply for help. Many people will go without preventive screenings, put off going to the doctor when sick and risk medical bankruptcies, she said.

MaryBeth Musumeci, an associate director for the Program on Medicaid and the Uninsured at the Washington-based Kaiser Family Foundation, a health policy think tank, said the red tape will be a barrier to health care.

“Those who are already working still must successfully document and verify their compliance. Those who qualify for an exemption also must successfully document and verify their exempt status, which could be as often as monthly. There is a real risk of eligible people losing coverage due to their inability to navigate this process or miscommunication or other breakdowns in the administrative process,” Musumeci said.

A Kaiser foundation summary of scholarly research shows that Medicaid as it is currently constituted – without work requirements or premiums – helps low-income people with employment, pointing to studies that were done in Ohio and Michigan.

According to a Kaiser foundation analysis in August, “Health coverage through Medicaid is an important precursor to and support for work. Many of the jobs held by people with low incomes involve walking, standing, lifting and carrying objects, repetitive motions and other physical labor. Without health insurance, individuals may forgo needed services, and their health may deteriorate to a point that interferes with their ability to work.

“An analysis of Ohio’s Medicaid expansion found that over half of enrollees who are working (without being required to do so) reported that having Medicaid made it easier for them to continue working,” the foundation analysis says. “A study examining Michigan’s Medicaid expansion found that nearly seven in 10 enrollees who were working said they performed better at work once they got Medicaid coverage.”

LePage said work requirements under a different public assistance program, Temporary Assistance for Needy Families, have benefited Mainers, and he believes Medicaid would see similar results.

“We want to see the same successes that Maine’s TANF beneficiaries have realized,” he said. “These work-oriented activities end isolation, build relationships, improve quality of life and help move our economy forward.”

“It is important to continue our efforts to break the cycle of poverty here in Maine,” Hamilton said in a written statement.

But Judy Bullard, 56, of Old Orchard Beach, a self-employed artist who receives Medicaid benefits through the MaineCare program, said she is concerned about the work requirement. Bullard said she has epilepsy and other medical conditions that make working long hours impossible.

It’s unclear whether Bullard would be required to work or volunteer under the waiver request, because Maine’s application provides for a number of exemptions to the work requirement. These include being medically frail, a caregiver, a student or receiving treatment for substance-use disorders.

Bullard said it shouldn’t matter what someone’s situation is – they deserve health care coverage regardless.

“We should not be jeopardizing anyone’s health care,” said Bullard, who testified against Maine’s application at a public hearing in Portland last May. “Health care should be a right, not a privilege. No one should be questioning why I get health care or anyone gets the health care that they need.”

CONFLICTING VIEWS ON THE CHANGE

The Trump administration move also was criticized by AARP and Maine Rep. Chellie Pingree, D-1st District, who called it “purely political, cynical and an inhumane attack on vulnerable people.”

But Mary Mayhew, a former Maine DHHS commissioner who spearheaded a number of reforms to the state’s public assistance programs under LePage, said in a statement that the waiver will help Maine prioritize its neediest populations.

“We have an opportunity to reshape our program and tailor it to best serve the needs of our state,” said Mayhew, who is seeking the Republican nomination for governor this year. “We must re-establish Medicaid’s core mission of supporting the elderly, disabled and children. That is what is best for the people of Maine and the future of our state.”

Maine also wants to remove “retroactive eligibility” that permits those eligible for Medicaid to get coverage for conditions that occurred up to three months before enrolling in Medicaid. A Kaiser foundation issue brief in November 2017 noted that removing such retroactive eligibilities hasn’t been studied much, but that the reason Medicaid allows people to receive such benefits is to protect patients who suddenly become ill from financial ruin.

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